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Physio findings

PHYSIOTHERAPY Editor Michele Harms presents A SUMMARY OF the latest issue of the CSP’s academic journal and Janet Wright rounds up other research Help for hamstrings

What interventions can physiotherapists use or advise athletes to prevent hamstring injuries? The June issue – Physiotherapy 2011: 97 (2) June – includes a Cochrane systematic review of interventions for preventing hamstring injuries (Goldman EF, Jones DE. Physiotherapy 2011; 97: 91–99.).

The review focuses on the evidence for: strengthening the hamstrings, manual therapy, a proprioceptive protocol and a warm-up, cool down and stretching protocol. The authors identify contradictory findings with no clear evidence that these strategies reduce injury in football or other high-risk activities.

This review provides a useful summary for clinicians and for those who are planning a study to look at injury prevention.

Emergency – see the physio


In recent years, the journal has included papers of interest to extended scope practitioners and on direct access to physiotherapy. This theme is now continued by Australian researchers. Nicholas Taylor and his co-authors report the results of a controlled trial of 305 adults presenting to emergency departments with peripheral musculoskeletal injuries (Taylor NF et al. Physiotherapy 2011; 97: 107-114). 

With the rising presence of physiotherapists in emergency departments, this is an interesting area of study. The authors found that initial contact with the physiotherapist in the emergency department could reduce the length of attendance for patients with peripheral musculoskeletal injuries when compared with those attending physiotherapy following initial assessment by a doctor.

There were no differences between those who had seen the physiotherapist first and those who had seen the doctor first in the number of imaging referrals or re-presentations.

Ultrasound tackles inflammation


Luis Signori and colleagues report on a laboratory study which looks at the effect of pulsed ultrasound on acute muscular inflammation (Signori LU et al. Physiotherapy 2011; 97: 163-169).

 More work along these lines is essential to develop the evidence base of so many of the techniques and methods used by physiotherapists.

Under the conditions that were used in the study, the results suggest that ultrasound could reduce inflammation.

Gap between research and practice

Nigel Hanchard and team report on a study of almost 300 physiotherapists, surveyed about their approach to the diagnosis and management of contracted (frozen) shoulder.

The authors distinguish between the preferred treatment options when stiffness predominates and where pain predominates. They discuss the disparity between clinical practice and research evidence, particularly interesting on the subject of short-wave diathermy.

They also highlight the confusion that exists over the definition of commonly used terms like ‘capsular pattern’ (Hanchard NCA et al. Physiotherapy 2011; 97: 115–125).

Measuring pelvic floor strength

A collaboration between researchers in Brazil and Kari Bø in Oslo reports on the inter-rater reliability of the Oxford Grading Scale and the Peritron manometer to measure pelvic floor muscle strength.

 Inter-rater reliability was only found to be ‘fair’ when using the Modified Oxford Grading Scale, and marginally better when using the Peritron manometer, although it was acknowledged that there are differences in what each method measures (Ferreira CHJ et al. Physiotherapy 2011; 97: 132-138).

 These results support other work carried out by Bø and colleagues. The authors identify a convincing need for the development of new measures and refinement of existing measures of pelvic floor muscle strength.

No need for excess calcium in later age

Calcium supplements are popular among people concerned about osteoporosis and fractures, especially older women. The recommended calcium intake for over-fifties varies from 700mg in the UK to 1200mg or more in the USA.

But researchers in Sweden have found that a daily intake of 750mg calcium is the right amount to protect ageing bones.

They reviewed data from a 19-year study of more than 60,000 women aged 39-plus at the outset. The information provided by participants covered execise, education, smoking, weight, HRT and use of vitamin and mineral supplements.

Those with the lowest risk of osteoporosis and fractures were consuming about 750mg a day – available from a diet rich in dairy foods and green leafy vegetables. Increasing their intake or taking more than 750mg did not help.

The authors noted some evidence that high intake of calcium may actually increase the rate of hip fractures, though they stress that that result should be interpreted with caution.

Warensjö E et al. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ 2011; 342:d1473, doi: 10.1136/bmj.d1473.

Never give up after a stroke

Physiotherapy plays an important role in rehabilitation after a stroke, as research has frequently shown. But in many areas, the provision of long-term services is patchy.

New research adds to the evidence that physiotherapy can go on aiding recovery, even long after a patient leaves hospital.

 A group of Italian researchers conducted a systematic review of published studies to evaluate the effect of physiotherapy programmes carried out six months or more after a stroke.

They found that a variety of physiotherapy interventions improve functional outcomes, especially walking, even when applied late after a stroke.

‘These findings challenge the concept of a plateau in functional recovery of patients who had experienced stroke and should be valued in planning community rehabilitation services,’ say the researchers.

Ferrarello F et al. Efficacy of physiotherapy interventions late after stroke: a meta-analysis. J Neurol Neurosurg Psychiatry 2011; 82 (2): 136-43.


Pain and disability from knee osteoarthritis can be eased by strength training, or exercise therapy, or exercise therapy with passive manual mobilisation, researchers found after doing a systematic review of randomised controlled trials. Exercise plus manual mobilisation was best for pain, showing a moderate effect compared to the small effect of strength training or exercise therapy alone. For better pain relief, the researchers suggest adding manual mobilisation to optimise supervised exercise programmes.

Jansen MJ et al. J Physiotherapy 2011; 57 (1); 11–20.

 In a study of 565 patients on sick-leave with chronic lower back pain, 31 per cent had at least one current psychiatric disorder. The most common were somatoform disorders (18 per cent) and anxiety disorders (12 per cent); 4 per cent had major depressive disorders. As these disorders can have serious effects on outcomes, the authors recommend screening CLBP patients in secondary care.

Reme S.E. et al. Eur J Pain 2011. doi:10.1016/j.ejpain.2011.04.012.

Crossing their arms reduced the pain volunteers felt when their hands were stimulated by lasers, by reducing the brain’s ability to place exactly where the sensation was.

Gallace A et al. Pain 2011; 152, 1418–1423.

The Chinese exercise routine tai chi has particular health benefits for older people, including helping to prevent falls and improving mental wellbeing, researchers have found after reviewing 35 studies. However, tai chi does not improve the symptoms of cancer or rheumatoid arthritis, as some have claimed.

Lee MS, Ernst E. Br J Sports Med 2011; doi:10.1136/bjsm.2010.080622.

Rehabilitation combined with mental practice (including imagery skills)  has similar effects on mobility to rehabilitation with relaxation in people with Parkinson’s disease, researchers in the Netherlands have found, in a multicentre randomised trial.

Braun S et al. J Physiotherapy 2011; 57(1):27–34.

Want to share?

Have you read a published study recently that you found useful in your physiotherapy practice? Or one that was interesting for other reasons, perhaps because the results surprised you, or backed up an idea you hadn’t seen proven, or provided an unusual insight into some aspect of your work? If you’d like to share that with other physios, please send the reference to, with your comment about it if you like. If we publish it in Physio findings, we’ll put your name on it (unless you ask us not to).


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